Uterine Leiomyomata

Excerpt

Uterine fibroids or leiomyomata are the most common benign tumor affecting women. An early 2003 study by Baird et al. showed that the estimated incidence of fibroids in women by age 50 was 70% for white women and reached over 80% black women. Fibroids originate from uterine smooth muscle cells (myometrium) whose growth is primarily dependent on the levels of circulating estrogen. Further information regarding the pathogenesis of fibroids is poorly understood. Fibroids can either present as an asymptomatic incidental finding on imaging, or symptomatically. Common symptoms include abnormal uterine bleeding, pelvic pain, disruption of surrounding pelvic structures(bowel and bladder), and back pain. Uterine fibroids typically are seen in three significant locations: subserosal (outside the uterus), intramural (inside the myometrium), and submucosal (Inside the uterine cavity). They can further be broken down to pedunculated or not. Fibroids are classically diagnosed by physical exam and ultrasound imaging, which carries a high sensitivity for this pathology. Fibroids continue to be the leading indication for hysterectomy. According to De La Cruz et al., leiomyomata account for 39% of all hysterectomies annually. This pathology places a financial burden on health care costs in the US. According to Cardozo et al., in 2013, the estimated cost for the US due to uterine fibroids was between $5.9 to $34.4 billion annually. The expectation is that this number will continue to grow in the coming years.